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2.
Nephrol Nurs J ; 47(5): 483-487, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107722

RESUMO

Abstract.


Assuntos
Cateterismo/métodos , Autocuidado/métodos , Humanos
3.
Medicine (Baltimore) ; 99(44): e22741, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126311

RESUMO

Percutaneous balloon dilatation for benign biliary-enteric anastomosis stricture has been the most widely used alternative to endoscopic treatment. However, patency results from the precedent literature are inconsistent.The objective of this study was to evaluate the safety and feasibility of repeated balloon dilatation with long-term biliary drainage for the treatment of benign biliary-enteric anastomosis strictures.Data from patients with benign biliary-enteric anastomosis strictures who underwent percutaneous transhepatic cholangiography (PTC), repeated balloon dilatation with long-term biliary drainage (repeated-dilatation group; n = 23), or PTC and single balloon dilatation with long-term biliary drainage (single-dilatation group; n = 26) were reviewed. Postoperative complications, jaundice remission, and sustained anastomosis patency were compared between the groups.All procedures were successful. No severe intraoperative complications, such as biliary bleeding and perforation, were observed. The jaundice remission rate in the first week was similar in the 2 groups. During the 26-month follow-up period, 3 patients in the repeated-dilatation group had recurrences (mean time to recurrence: 22.84 ±â€Š0.67 months, range: 18-26 months). In the single-dilatation group, 15 patients had recurrences (mean time to recurrence = 15.28 ±â€Š1.63 months, range: 3-18 months). The duration of patency after dilatation was significantly better in the repeated-dilatation group (P = .01). All patients with recurrence underwent repeat PTC followed by balloon dilatation and biliary drainage.Repeated balloon dilatation and biliary drainage is an effective, minimally invasive, and safe procedure for treating benign biliary-enteric anastomosis strictures, and provides significantly higher patency rates than single dilatation.


Assuntos
Cateterismo/métodos , Dilatação/métodos , Drenagem/métodos , Complicações Pós-Operatórias/cirurgia , Estomas Cirúrgicos/efeitos adversos , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estomas Cirúrgicos/patologia , Resultado do Tratamento
4.
J Card Surg ; 35(10): 2495-2499, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32939799

RESUMO

OBJECTIVE: Since the initiation of an adult extracorporeal membrane oxygenation (ECMO) program at our institution, the program has managed well over 200 patients with ECMO in a 3-year time frame. While there is a plethora of research evaluating ECMO for acute respiratory distress syndrome (ARDS), few studies have evaluated the impact that ventilator management after cannulation might have on outcomes. We hypothesized that failure to properly protect the lungs after cannulation would lead to higher mortality. MATERIALS AND METHODS: This was a retrospective observational study performed from 1 January 2014 to 8 July 2018. RESULTS: A total of 196 patients were treated with ECMO, 57 of whom were diagnosed with ARDS and treated with venovenous ECMO. The univariable analysis revealed a statistically higher total serum bilirubin and lower total days on ECMO in those who died vs those who lived. During ECMO, higher mean peak inspiratory pressures (PIP) and higher FiO2 were found in those who died vs those who lived. In multivariable analysis, increasing age (odds ratio [OR] = 1.2; confidence interval [CI] = 1.04-1.39, P = .02), increasing mean PIP, and increasing mean FiO2 concentration during ECMO (PIP: OR = 1.40, CI = 1.03-1.89, P = .03; FiO2 : OR = 1.16, CI = 1.02-1.32, P = .02) were all associated with increased mortality. CONCLUSION: Failing to protect the lungs with a lung protective strategy such as the EMPROVE protocol after ECMO cannulation was associated with mortality. For every 1 mm Hg increase in the mean PIP, the odds of dying increased 1.4 times, and for every 1% increase in the mean FiO2 , the odds of dying increased 1.16 times. For lung rest to truly be effective, the lungs must be relieved of the burden of gas exchange.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Cateterismo/métodos , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Troca Gasosa Pulmonar , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Resultado do Tratamento
5.
PLoS One ; 15(9): e0238952, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941466

RESUMO

OBJECTIVE: To meet increasing demands to train neuroendovascular techniques, we developed a dedicated simulator applying individualized three-dimensional intracranial aneurysm models ('HANNES'; Hamburg Anatomic Neurointerventional Endovascular Simulator). We hypothesized that HANNES provides a realistic and reproducible training environment to practice coil embolization and to exemplify disparities between neurointerventionalists, thus objectively benchmarking operators at different levels of experience. METHODS: Six physicians with different degrees of neurointerventional procedural experience were recruited into a standardized training protocol comprising catheterization of two internal carotid artery (ICA) aneurysms and one basilar tip aneurysm, followed by introduction of one framing coil into each aneurysm and finally complete coil embolization of one determined ICA aneurysm. The level of difficulty increased with every aneurysm. Fluoroscopy was recorded and assessed for procedural characteristics and adverse events. RESULTS: Physicians were divided into inexperienced and experienced operators, depending on their experience with microcatheter handling. Mean overall catheterization times increased with difficulty of the aneurysm model. Inexperienced operators showed longer catheterization times (median; IQR: 47; 30-84s) than experienced operators (21; 13-58s, p = 0.011) and became significantly faster during the course of the attempts (rho = -0.493, p = 0.009) than the experienced physicians (rho = -0.318, p = 0.106). Number of dangerous maneuvers throughout all attempts was significantly higher for inexperienced operators (median; IQR: 1.0; 0.0-1.5) as compared to experienced operators (0.0; 0.0-1.0, p = 0.014). CONCLUSION: HANNES represents a modular neurointerventional training environment for practicing aneurysm coil embolization in vitro. Objective procedural metrics correlate with operator experience, suggesting that the system could be useful for assessing operator proficiency.


Assuntos
Educação Médica/métodos , Embolização Terapêutica/métodos , Treinamento por Simulação/métodos , Adulto , Prótese Vascular , Cateterismo/métodos , Angiografia Cerebral/métodos , Simulação por Computador , Estudos de Viabilidade , Feminino , Humanos , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos
6.
Cochrane Database Syst Rev ; 8: CD007372, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32852803

RESUMO

BACKGROUND: The setting in which induction of labour takes place (home or inpatient) is likely to have implications for safety, women's experiences and costs. Home induction may be started at home with the subsequent active phase of labour happening either at home or in a healthcare facility (hospital, birth centre, midwifery-led unit). More commonly, home induction starts in a healthcare facility, then the woman goes home to await the start of labour. Inpatient induction takes place in a healthcare facility where the woman stays while awaiting the start of labour. OBJECTIVES: To assess the effects on neonatal and maternal outcomes of third trimester home induction of labour compared with inpatient induction using the same method of induction. SEARCH METHODS: For this update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (31 January 2020)), and reference lists of retrieved studies. SELECTION CRITERIA: Published and unpublished randomised controlled trials (RCTs) in which home and inpatient settings for induction have been compared. We included conference abstracts but excluded quasi-randomised trials and cross-over studies. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study reports for inclusion. Two review authors carried out data extraction and assessment of risk of bias independently. GRADE assessments were checked by a third review author. MAIN RESULTS: We included seven RCTs, six of which provided data on 1610 women and their babies. Studies were undertaken between 1998 and 2015, and all were in high- or upper-middle income countries. Most women were induced for post dates. Three studies reported government funding, one reported no funding and three did not report on their funding source. Most GRADE assessments gave very low-certainty evidence, downgrading mostly for high risk of bias and serious imprecision. 1. Home compared to inpatient induction with vaginal prostaglandin E (PGE) (two RCTs, 1028 women and babies; 1022 providing data). Although women's satisfaction may be slightly better in home settings, the evidence is very uncertain (mean difference (MD) 0.16, 95% confidence interval (CI) -0.02 to 0.34, 1 study, 399 women), very low-certainty evidence. There may be little or no difference between home and inpatient induction for other primary outcomes, with all evidence being very low certainty: - spontaneous vaginal birth (average risk ratio (RR) [aRR] 0.91, 95% CI 0.69 to 1.21, 2 studies, 1022 women, random-effects method); - uterine hyperstimulation (RR 1.19, 95% CI 0.40 to 3.50, 1 study, 821 women); - caesarean birth (RR 1.01, 95% CI 0.81 to 1.28, 2 studies, 1022 women); - neonatal infection (RR 1.29, 95% CI 0.59 to 2.82, 1 study, 821 babies); - admission to neonatal intensive care unit (NICU) (RR 1.20, 95% CI 0.50 to 2.90, 2 studies, 1022 babies). Studies did not report serious neonatal morbidity or mortality. 2. Home compared to inpatient induction with controlled release PGE (one RCT, 299 women and babies providing data). There was no information on whether the questionnaire on women's satisfaction with care used a validated instrument, but the findings presented showed no overall difference in scores. We found little or no difference between the groups for other primary outcomes, all also being very low-certainty evidence: - spontaneous vaginal birth (RR 0.94, 95% CI 0.77 to 1.14, 1 study, 299 women); - uterine hyperstimulation (RR 1.01, 95% CI 0.51 to 1.98, 1 study, 299 women); - caesarean births (RR 0.95, 95% CI 0.64 to 1.42, 1 study, 299 women); - admission to NICU (RR 1.38, 0.57 to 3.34, 1 study, 299 babies). The study did not report on neonatal infection nor serious neonatal morbidity or mortality. 3. Home compared to inpatient induction with balloon or Foley catheter (four RCTs; three studies, 289 women and babies providing data). It was again unclear whether questionnaires reporting women's experiences/satisfaction with care were validated instruments, with one study (48 women, 69% response rate) finding women were similarly satisfied. Home inductions may reduce the number of caesarean births, but the data are also compatible with a slight increase and are of very low-certainty (RR 0.64, 95% CI 0.41 to 1.01, 2 studies, 159 women). There was little or no difference between the groups for other primary outcomes with all being very low-certainty evidence: - spontaneous vaginal birth (RR 1.04, 95% CI 0.54 to 1.98, 1 study, 48 women): - uterine hyperstimulation (RR 0.45, 95% CI 0.03 to 6.79, 1 study, 48 women); - admission to NICU (RR 0.37, 95% CI 0.07 to 1.86, 2 studies, 159 babies). There were no serious neonatal infections nor serious neonatal morbidity or mortality in the one study (involving 48 babies) assessing these outcomes. AUTHORS' CONCLUSIONS: Data on the effectiveness, safety and women's experiences of home versus inpatient induction of labour are limited and of very low-certainty. Given that serious adverse events are likely to be extremely rare, the safety data are more likely to come from very large observational cohort studies rather than relatively small RCTs.


Assuntos
Assistência Ambulatorial/métodos , Maturidade Cervical , Hospitalização , Trabalho de Parto Induzido/métodos , Cateterismo/métodos , Cesárea/estatística & dados numéricos , Preparações de Ação Retardada , Dinoprostona , Feminino , Humanos , Recém-Nascido , Tempo de Internação , Ocitócicos , Segurança do Paciente , Satisfação do Paciente , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
PLoS One ; 15(7): e0235757, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645076

RESUMO

Thus far, no curved linear array endoscopic ultrasound (CLAEUS) findings were established as predictors of difficult selective bile duct cannulation (SBDC). This study aimed to identify CLAEUS findings to predict endoscopic retrograde cholangiopancreatography (ERCP) cases with difficult SBDC. This single-center, retrospective cohort study was conducted between July 2014 and June 2017. This study included all consecutive patients who underwent CLAEUS prior to naïve ERCP. A CLAEUS finding of the simultaneous depiction of bile and pancreatic ducts at the second portion of the duodenum (D2) (simultaneous depiction) was selected as a possible predictor of difficult SBDC, and the κ values in the evaluation of inter- and intra-observer variabilities for "simultaneous depiction" were 0.65 and 0.77, respectively, with substantial correlation. Among the 986 patients who underwent ERCP, 80 patients were relevant for evaluation. Logistic regression analysis revealed strong association between "simultaneous depiction" and difficult SBDC (odds ratio 15.4, 95% confidence interval 4.2-56.0; p<0.001). Among patients who underwent CLAEUS prior to naïve ERCP, a strong correlation was observed between "simultaneous depiction" and the risk of difficult SBDC. An endoscopist can prepare for difficult SBDC by "simultaneous depiction." The finding enables pertinent planning when performing ERCP, such as setting time limits and selecting alternative devices, techniques, and skilled endoscopists, for difficult SBDC with minimal complications including post-ERCP pancreatitis. However, a future prospective study is necessary to establish the procedure algorithm for suspected difficult SBDC cases based on CLAEUS.


Assuntos
Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Endossonografia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Ductos Biliares/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos/diagnóstico por imagem , Pancreatite/etiologia , Complicações Pós-Operatórias , Estudos Retrospectivos
8.
J Card Surg ; 35(10): 2794-2797, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720393

RESUMO

Extracorporeal membrane oxygenation (ECMO) is a technology that has allowed further cardiopulmonary support in the setting of respiratory failure refractory to mechanical ventilation. While it has evolved since its first description, one area of improvement continues to be its implementation. With advancements in cannulation techniques, in recent years, there has been a plethora of new cannulas that has been introduced in the market. For urgent venous-venous cannulation, the right internal jugular vein along with either femoral veins remain the most utilized strategy due to minimal need for imaging support. This allows for safe bedside cannulation. However, as the number of days of ECMO support continue to increase, transitioning to a cannulation strategy that is easier to ambulate with and more comfortable is preferred. Therefore, we describe a method for transitioning from right jugular-femoral cannulation to left subclavian placement of the Crescent Dual-Lumen catheter without interrupting ECMO support.


Assuntos
Cânula , Cateterismo/métodos , Oxigenação por Membrana Extracorpórea/métodos , Veia Femoral/cirurgia , Veias Jugulares/cirurgia , Insuficiência Respiratória/terapia , Veia Subclávia/cirurgia , Doença Aguda , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo
9.
J Card Surg ; 35(6): 1180-1185, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-596751

RESUMO

BACKGROUND: Patient selection and cannulation arguably represent the key steps for the successful implementation of extracorporeal membrane oxygenation (ECMO) support. Cannulation is traditionally performed in the operating room or the catheterization laboratory for a number of reasons, including physician preference and access to real-time imaging, with the goal of minimizing complications and ensuring appropriate cannula positioning. Nonetheless, the patients' critical and unstable conditions often require emergent initiation of ECMO and preclude the safe transport of the patient to a procedural suite. AIMS: Therefore, with the objective of avoiding delay with the initiation of therapy and reducing the hazard of transport, we implemented a protocol for bedside ECMO cannulation. MATHERIAL AND METHODS: A total of 89 patients required ECMO support at Hennepin County Medical Center between March 2015 and December 2019. Twenty-eight (31%) required veno-venous support and were all cannulated at the bedside. Overall survival was 71% with no morbidity or mortality related to the cannulation procedure. CONCLUSION: In the current pandemic, the strategy of veno-venous bedside cannulation may have additional benefits for the care of patients with refractory acute respiratory distress syndrome due to coronavirus-disease-2019, decreasing the risk of exposure of health care worker or other patients to the novel severe acute respiratory syndrome coronavirus-2 occurring during patient transport, preparation, or during disinfection of the procedural suite and the transportation pathway after ECMO cannulation.


Assuntos
Cateterismo/métodos , Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea/métodos , Mortalidade Hospitalar , Pandemias/prevenção & controle , Pneumonia Viral/terapia , Gestão da Segurança/métodos , Betacoronavirus , Cateterismo/estatística & dados numéricos , China , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
10.
J Card Surg ; 35(6): 1180-1185, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32531129

RESUMO

BACKGROUND: Patient selection and cannulation arguably represent the key steps for the successful implementation of extracorporeal membrane oxygenation (ECMO) support. Cannulation is traditionally performed in the operating room or the catheterization laboratory for a number of reasons, including physician preference and access to real-time imaging, with the goal of minimizing complications and ensuring appropriate cannula positioning. Nonetheless, the patients' critical and unstable conditions often require emergent initiation of ECMO and preclude the safe transport of the patient to a procedural suite. AIMS: Therefore, with the objective of avoiding delay with the initiation of therapy and reducing the hazard of transport, we implemented a protocol for bedside ECMO cannulation. MATHERIAL AND METHODS: A total of 89 patients required ECMO support at Hennepin County Medical Center between March 2015 and December 2019. Twenty-eight (31%) required veno-venous support and were all cannulated at the bedside. Overall survival was 71% with no morbidity or mortality related to the cannulation procedure. CONCLUSION: In the current pandemic, the strategy of veno-venous bedside cannulation may have additional benefits for the care of patients with refractory acute respiratory distress syndrome due to coronavirus-disease-2019, decreasing the risk of exposure of health care worker or other patients to the novel severe acute respiratory syndrome coronavirus-2 occurring during patient transport, preparation, or during disinfection of the procedural suite and the transportation pathway after ECMO cannulation.


Assuntos
Cateterismo/métodos , Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea/métodos , Mortalidade Hospitalar , Pandemias/prevenção & controle , Pneumonia Viral/terapia , Gestão da Segurança/métodos , Betacoronavirus , Cateterismo/estatística & dados numéricos , China , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
11.
Oncology ; 98(8): 558-565, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32422633

RESUMO

BACKGROUND AND AIMS: Conventional transcatheter arterial chemoembolization (C-TACE) and drug-eluting bead (DEB)-based TACE are current treatments for hepatocellular carcinoma (HCC). We compared the therapeutic efficacies and adverse events of these methods in a single-center retrospective cohort study. METHODS: We enrolled 174 patients treated between January 2010 and October 2016; 98 and 76 underwent C-TACE and DEB-TACE, respectively, with 76 and 22 of the former group and 49 and 27 of the latter group classified as Child-Pugh class A and B, respectively. Therapeutic outcomes, progression-free survival (PFS), and adverse events were evaluated. RESULTS: The PFS rates in the C-TACE and DEB-TACE groups were 8.1 and 6.1 months, respectively (p = 0.79). The response and disease control rates were 64 and 71% in C-TACE patients and 69 and 78% in DEB-TACE patients, respectively (p = 0.25). Postprocedural pain, vomiting, and fever were more frequent following C-TACE than DEB-TACE (p < 0.001). In contrast, the incidences of bilomas and arterio-portal shunts were significantly higher following DEB-TACE (p < 0.001); the incident rates of arterio-portal shunt formation were 8.1 and 48.7% in patients undergoing C-TACE and DEB-TACE, respectively. Child-Pugh class A was significantly associated with arterio-portal shunt formation after DEB-TACE on multivariate analysis. CONCLUSIONS: There were no significant differences in the therapeutic efficacies of C-TACE and DEB-TACE. However, the frequency of arterio-portal shunt formation was significantly higher in HCC patients with Child-Pugh class A undergoing DEB-TACE. Our findings imply that C-TACE should be selected for HCC patients with Child-Pugh class A and DEB-TACE should be chosen for those with Child-Pugh class B.


Assuntos
Fístula Arteriovenosa/etiologia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/métodos , Sistemas de Liberação de Medicamentos/efeitos adversos , Sistemas de Liberação de Medicamentos/métodos , Neoplasias Hepáticas/terapia , Idoso , Idoso de 80 Anos ou mais , Antibióticos Antineoplásicos/administração & dosagem , Cateterismo/métodos , Epirubicina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Retrospectivos
12.
Curr Urol Rep ; 21(6): 23, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32378073

RESUMO

PURPOSE OF THE REVIEW: We investigate articles in the literature published in the last 5 years (2014-2019) regarding ultrasound education in the specialty of urology. RECENT FINDINGS: Ultrasound has been touted as the modern day stethoscope. Medical educational governing bodies have encouraged the incorporation of ultrasound in medical school education. However, in this review, we find that there are gaps in educational opportunities and standardization in residency and continuing education for urology practitioners. We have identified several new tools for procedure-specific training published in the last 5 years including MRI fusion prostate biopsy and percutaneous nephrolithotomy. New technology is being fused with traditional ultrasound training to provide procedure-specific ultrasound knowledge. There is a need to incorporate new technology and standards into resident and continuing medical education.


Assuntos
Internato e Residência/métodos , Nefrolitotomia Percutânea/métodos , Ultrassonografia , Urologia/educação , Cateterismo/métodos , Currículo , Educação Médica Continuada/métodos , Humanos , Hidronefrose/diagnóstico por imagem , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Masculino , Imagem Multimodal , Próstata/patologia , Treinamento por Simulação , Ultrassonografia de Intervenção , Realidade Virtual
13.
Obstet Gynecol ; 135(5): 1153-1160, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32282603

RESUMO

OBJECTIVE: To evaluate whether removal of a double-balloon device for cervical ripening for 6 compared with 12 hours in women with an unfavorable cervix will result in a shorter time to delivery, similar cervical ripening, and without affecting cesarean delivery rate. METHODS: In a prospective randomized trial, cervical ripening was performed using a double-balloon device. Women were randomized to removal of the device after 6 compared with 12 hours. Primary outcome was time to delivery. Secondary outcomes included mode of delivery, Bishop score, and maternal and neonatal adverse outcomes. A sample size of 100 nulliparous and 100 parous women was required assuming a 95% CI, power of 80%, and mean decrease of 6 hours to delivery between the groups. RESULTS: From March 2017 through February 2019, 688 women were screened, 243 were found eligible, and 197 were randomized as follows: nulliparous cohort (n=101): removal after 6 hours (n=48) compared with removal after 12 hours (n=53); parous cohort (n=96): removal after 6 hours (n=49) compared with removal after 12 hours (n=47). Insertion-to-delivery interval was significantly shorter in the 6-hour group for both nulliparous (25.6±12.8 hours vs 31.4±15.2 hours, P<.04; mean difference 5.8, 95% CI 0.2-11.3), and parous cohorts (18.0±6.8 hours vs 22.6±8.2 hours, P=.003; mean difference 4.7, 95% CI 1.6-7.7). Bishop score change and cesarean delivery rate were similar between groups regardless of parity. The 12-hour group in the combined cohort was associated with higher rates of maternal intrapartum fever (2% vs 10%, P=.02; odds ratio 5.3, 95% CI 1.1-24.8). CONCLUSION: Insertion-to-delivery interval is shorter after 6 compared with 12 hours for both nulliparous and parous women. Cervical ripening with a double-balloon device may be achieved in 6 hours. The longer time was associated with a higher rate of intrapartum fever. Six hours should be considered as standard placement time for double-balloon catheters. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03045939.


Assuntos
Cateterismo/métodos , Maturidade Cervical , Trabalho de Parto Induzido/métodos , Ocitócicos/administração & dosagem , Fatores de Tempo , Adulto , Cateterismo/efeitos adversos , Colo do Útero , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Febre/induzido quimicamente , Febre/epidemiologia , Humanos , Trabalho de Parto Induzido/efeitos adversos , Paridade , Gravidez , Complicações na Gravidez/induzido quimicamente , Complicações na Gravidez/epidemiologia , Estudos Prospectivos
14.
J Clin Ultrasound ; 48(5): 298-300, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32302016

RESUMO

Cesarean scar pregnancies are relatively rare. In the first trimester, if the decision is made to terminate the pregnancy, it should be done as soon as possible to avoid complications. We report a successful termination of a live, 6 weeks and 4 days cesarean scar pregnancy using a double-balloon cervical ripening catheter in a patient with two previous cesarean deliveries.


Assuntos
Aborto Eugênico/métodos , Cateterismo/métodos , Maturidade Cervical , Gravidez Ectópica/terapia , Solução Salina/administração & dosagem , Ultrassonografia de Intervenção/métodos , Adulto , Cesárea , Cicatriz , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos
15.
J Card Surg ; 35(5): 1037-1042, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32227395

RESUMO

OBJECTIVES: Central or peripheral venoarterial extracorporeal membrane oxygenation (va ECMO) is widely used in postcardiotomy cardiogenic shock (PCS). Available data suggest controversial results for both types. Our aim was to investigate PCS patients treated with either peripheral (pECMO) or central ECMO (cECMO) concerning their outcome. METHODS: Between April 2006 and October 2016, 156 consecutive patients with va ECMO therapy due to PCS were identified and included in this retrospective analysis. Patients were divided into cECMO and pECMO groups. Statistical analysis of risk factors concerning 30-day mortality of the mentioned patient cohort was performed using IBM SPSS Statistics. RESULTS: Fifty-six patients received cECMO and 100 patients were treated with pECMO due to PCS. In the group of cECMO peripheral vascular disease was significantly more present (cECMO 19 [34%] vs pECMO 14 [14%]; P < .01). On-site ECMO complications occurred significantly more frequent in patients treated with cECMO (cECMO 44 [79%] vs pECMO 54 [54%] g/dL; P < 0.01). More often cECMO patients required a second look operation due to mediastinal bleeding (cECMO 52 [93%] vs pECMO 61 [61%] g/dL; P < .01). Thirty-day mortality was comparable with nearly 70% in both cohorts (cECMO 39 [70%] vs pECMO 69 [69%]; P = .93). CONCLUSION: Patients supported by cECMO or pECMO due to refractory PCS did not show significant differences in 30-day mortality, despite a lower incidence of on-site ECMO complications and re-exploration in pECMO patients. PCS itself is associated with high mortality and peripheral cannulation might help to save resources compared with central cannulation.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Oxigenação por Membrana Extracorpórea/métodos , Complicações Pós-Operatórias/terapia , Choque Cardiogênico/terapia , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Cateterismo/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/mortalidade
16.
Arch Gynecol Obstet ; 301(4): 931-940, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32140810

RESUMO

PURPOSE: To compare the effectiveness of cervical ripening by a mechanical method (double-balloon catheter) and a pharmacological method (prostaglandins) in women with one previous cesarean delivery, an unfavorable cervix (Bishop score < 6), and a singleton fetus in cephalic presentation. METHODS: This retrospective study, reviewing the relevant records for the years 2013 through 2017, took place in two French university hospital maternity units. This study included women with one previous cesarean delivery, a liveborn singleton fetus in cephalic presentation, and intact membranes, for whom cervical ripening, with unfavorable cervix (Bishop score < 6) was indicated for medical reasons. It compared two groups: (1) women giving birth in a hospital that uses a protocol for mechanical cervical ripening by a double-balloon catheter (DBC), and (2) women giving birth in a hospital that performed pharmacological cervical ripening by prostaglandins. The principal endpoint was the cesarean delivery rate. The secondary outcome measures were maternal and neonatal outcomes. RESULTS: We compared 127 women with prostaglandin ripening to 117 women with DBC. There was no significant difference between the two groups for the cesarean rate (42.5% in the prostaglandin group and 42.7% in the DBC group; p = 0.973; crude OR 1.01 [0.61-1.68]; adjusted OR 1.55 [0.71-3.37]). The median interval between the start of ripening and delivery did not differ between the groups (28.7 h in the prostaglandin group vs 25.6 h in the DBC group; p = 0.880). Neonatal outcomes did not differ between the groups, either. There was one case of uterine rupture in the prostaglandin group, with no associated maternal or neonatal morbidity. There were no neonatal deaths. The postpartum hemorrhage rate was significantly higher in the DBC group. CONCLUSION: For cervical ripening for women with one previous cesarean, the choice of a pharmacological or mechanical protocol does not appear to modify the mode of delivery or maternal or neonatal morbidity.


Assuntos
Cateterismo/métodos , Maturidade Cervical/fisiologia , Cesárea/métodos , Trabalho de Parto Induzido/métodos , Prostaglandinas/metabolismo , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos
17.
Intern Med ; 59(5): 683-687, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32115518

RESUMO

A 45-year-old man with idiopathic aplastic anemia required renal replacement therapy (RRT) due to end-stage renal disease (ESRD). We succeeded in inserting the peritoneal dialysis (PD) catheter under cover of frequent red blood cell and platelet infusions because of severe pancytopenia. During the one-year period after starting PD using an ultraviolet-ray sterilization device, he developed severe leukopenia but no PD-related peritonitis or exit site/tunnel infection until he died of pneumonia. This case suggests that PD might be a suitable choice as RRT in ESRD patients with aplastic anemia, even in those with severe pancytopenia.


Assuntos
Anemia Aplástica/complicações , Falência Renal Crônica/terapia , Diálise Peritoneal/instrumentação , Cateterismo/métodos , Cateteres de Demora , Transfusão de Eritrócitos , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Pancitopenia/complicações , Pancitopenia/terapia , Diálise Peritoneal/métodos , Peritonite/prevenção & controle , Transfusão de Plaquetas
18.
J Anim Sci ; 98(4)2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32206780

RESUMO

In order to further increase the stability of the cannula behind the ribs and to facilitate cannula exteriorization in growing pigs, the present study aimed to evaluate whether elongation of the cannula flange could increase the stability of the cannula behind the ribs and to develop a tool to improve the exteriorization of the cannula through the ribs. Moreover, it was assessed whether a special skin protection paste and soft polyurethane foam material used in daily skin care could prevent erythema around the fistula. The feasibility of both, the modified simple T-cannula and daily skin care procedure, was evaluated in a digestibility experiment. Simple T-cannulae were made of high-molecular-weight polyethylene and inserted into the distal ileum of eight growing pigs (average body weight at surgery 30 kg). Modifications in the cannula design included a longer flange (11 cm) that was narrowed from the center to the ends and a bending of the flange to adapt it to the curve of the costal arch. In order to reduce the damage to the thread on the outer cannula barrel during surgery, a special surgical plug in conjunction with a screw thread on the inside of the barrel was developed. With respect to the daily cleaning of the fistula, a special skin protection paste was applied on the skin around the fistula to create a waterproof film that entirely sealed the skin. Additionally, foam material was inserted between the retaining ring and the skin to absorb the leaking digesta. Monitoring of the pigs throughout the trial showed that modifications in cannula design proved to be useful as they facilitated exteriorization of the cannula through the ribs and stability of the cannula behind the ribs. Moreover, the use of the skin protection paste and foam material during postsurgical treatment of growing pigs effectively prevented skin irritation around the flank area.


Assuntos
Cânula/veterinária , Cateterismo/veterinária , Íleo/cirurgia , Higiene da Pele/veterinária , Suínos/cirurgia , Ração Animal , Animais , Peso Corporal , Cateterismo/métodos , Digestão/fisiologia
19.
Br J Radiol ; 93(1110): 20190830, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32208976

RESUMO

OBJECTIVES: To compare the performance of arterial spin labelling (ASL) in evaluating arteriovenous malformations (AVMs) against the current gold standard of catheter angiography. METHODS: We systematically reviewed the published literature using EMBASE and Medline. We included studies that compared ASL to catheter angiography in the assessment of AVMs in three outcome domains: detection, angioarchitectural and haemodynamic features. RESULTS: From 314 unique citations, 19 studies representing 289 patients with intracranial AVMs met our inclusion criteria. We did not pool data due to marked heterogeneity in study outcome measures. Seven studies showed high diagnostic performance of ASL in identifying arterial feeders, with sensitivity ranging from 84.6 to 100% and specificity ranging from 93.3 to 100%. Six studies showed strong ability in detecting arteriovenous shunting, with sensitivity ranging from 91.7 to 100% and specificity ranging from 90 to 100%. Seven studies demonstrated that ASL could identify nidal location and size as well as catheter angiography, while five studies showed relatively poorer performance in delineating venous drainage. Two studies showed 100% sensitivity of ASL in the identification of residual or obliterated AVMs following stereotactic radiosurgery. CONCLUSIONS: Despite limitations in the current evidence base and technical challenges, this review suggests that ASL has a promising role in the work-up and post-treatment follow-up of AVMs. Larger scale prospective studies assessing the diagnostic performance of ASL are warranted. ADVANCES IN KNOWLEDGE: ASL demonstrates overall validity in the evaluation of intracranial AVMs.


Assuntos
Angiografia Cerebral/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Cateterismo/métodos , Circulação Cerebrovascular , Humanos , Sensibilidade e Especificidade , Marcadores de Spin
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